Healthcare Provider Details

I. General information

NPI: 1265541429
Provider Name (Legal Business Name): BARBARA HOLLAND FLYNT-WAMPLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST UNAKA AVE
JOHNSON CITY TN
37601
US

IV. Provider business mailing address

149 SPRING BRANCH RD
BRISTOL VA
24201
US

V. Phone/Fax

Practice location:
  • Phone: 423-928-6993
  • Fax: 276-669-2159
Mailing address:
  • Phone: 276-669-4333
  • Fax: 276-669-2159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1112
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904002344
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: